AccountId: 011433970860
ContactId: 6b548ef8-f189-47e4-86b1-e8fe3db7c935
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 493880 ms
Total Talk Time (AGENT): 140650 ms
Total Talk Time (CUSTOMER): 243055 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/6b548ef8-f189-47e4-86b1-e8fe3db7c935_20250123T20:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling for DLP Western Carolina Fishing Practices. I verify the UB and this call is made for additional information about the dinner. Please note the call will be monitored and recorded for quality and training purposes.
[AGENT][NEUTRAL] OK, yeah, I can look, um, provide you some additional information for that claim and all, uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, sir, the callback number is [PII] and it's my direct line.
[AGENT][NEUTRAL] Alright, thank you. And do you have the policy number?
[CUSTOMER][NEUTRAL] Um, yes, I got the policy number the.
[CUSTOMER][NEUTRAL] Member ID number or the policy number is 253-6267.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] All right. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure, the patient's name is.
[CUSTOMER][NEUTRAL] [PII] and patient's date of birth is on [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. um, do you have the claim number?
[CUSTOMER][NEUTRAL] Um, yes, let me check with the claim number. Um, yes, I got the claim number. The claim number is, um, alright.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, it's 3546913.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh this was DLP Western Carolina physicians.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, bear with me just a moment. Let me take a look.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so we were unable to pay a benefit, Dominic, as this is not a covered diagnostic test for their benefit. Uh, their benefit coverage tests like MRI, CAT scan, CT scan, uh, things like that. This particular diagnostic test was not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] All right. And may I know if it is non-covered service as per provider's contract or patient's plan?
[AGENT][NEUTRAL] For this plan.
[CUSTOMER][NEUTRAL] All right, for the patient's plan, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And uh could you please provide me with the correct mailing address uh please?
[AGENT][NEUTRAL] Yeah it is um [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] All right. And I got the time the final limit as um one year from the data service to uh to submit a credit claim, is that correct sir?
[AGENT][NEUTRAL] No, it is um 180 days from the process date, so.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you so much and let me check if we have received any payments for this CPT code and I'm almost done.
[AGENT][NEUTRAL] Oh sure.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] It's nice.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, and I'm done with this claim there, and I'm ready for the call reference number for this claim.
[AGENT][NEUTRAL] OK, yeah, reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Yes, uh, [PII], I got one remaining claim. Is it possible to help me with one, with 11 claim?
[AGENT][NEUTRAL] Is this for the same member or is this for a different member?
[CUSTOMER][NEUTRAL] Um, it is for a different member.
[AGENT][NEUTRAL] OK, yes, one moment, I'll let you know when I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] OK, I am ready for the next policy number on it.
[CUSTOMER][NEUTRAL] Uh, sure.
[CUSTOMER][NEUTRAL] The member ID number is 02540092.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for this insured?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, patient's name is [PII] and patient's date of birth is on [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and then do you have the claim number for this one as well?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um, yes, I got the claim number. The claim number is 354-473-8.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Was this for a different provider?
[CUSTOMER][NEUTRAL] Um, yes, uh, [PII].
[AGENT][NEUTRAL] OK, Vaughan physician practices?
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for this time, [PII], um, their policy terminated [PII] and so as these services were rendered after coverage was terminated, we were unable to pay a benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Oh right.
[CUSTOMER][NEUTRAL] Mm I just want to check on information and
[CUSTOMER][NEUTRAL] Alright, I just want to check in the billing summary if you have received any payments after the termination date, uh, [PII], and I'm almost done.
[AGENT][POSITIVE] Oh, no worries.
[CUSTOMER][POSITIVE] Uh, sure, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And yes, I don't see any payments after [PII]. All right. And yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright, and let me um alright and I'm done [PII]h my claims [PII]. Thank you so much for your time and assistance and have a great day, yes.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL you too bye bye.
[CUSTOMER][POSITIVE] Bye for now. Thank you.